ABSTRACT
Objective To study the change of levator urethra gap(LUG) in postpartum female using pelvic floor three-dimensional ultrasonography.Methods Totally 80 postpartum women and 30 nulliparas were examined by three-dimensional pelvic floor ultrasonography.The images were obtained at maximal pelvic floor muscle contraction,and then the morphology of puborectalis muscle on tomographic ultrasound imaging were observed and the right LUG and left LUG were measured.Results The puborectalis was intact in all nulliparas and 69 postpartum women.The puborectalis avulsion was find in 11 postpartum women.The LUG of postpartum group was greater than that of nullipara group (P ＜0.05).In postpartum group,the LUG of puborectalis avulsion was greater than that of intact puborectalis(P ＜0.05).There was no difference between the right LUG and left LUG in nullipara group and in the postpartum women with intact puborectalis (P ＞ 0.05).ConcIusions LUG is a good imaging parameter to evaluate the levator avulsion in postpartum women.
ABSTRACT
Objective To investigate the relationship between pelvic floor dysfunction and serum relaxin H2 and expression of vaginal wall relaxin receptor LGR7 mRNA in late pregnant women. Methods Before the beginning of delivery,all women were evaluated by pelvic organ prolapse quantitation(POP-Q)scoring.Twelve women with stress urinary incontinence(SUI)and stage II prolapse of anterior vaginal wall were selected as patient group,and another 24 women without SUI and prolapse of pelvic floor were served as control group.Serum relaxin H2 was determined by ELISA.Vaginal wall tissues were taken after vaginal delivery,and the expression of relaxin receptor LGR7 mRNA was detected by RT-PCR.Results The serum level of relaxin H2 and expression of LGR7 mRNA of vaginal tissues in patient group were significantly higher than those in control group(P<0.01,P<0.05). Conclusion The increased level of serum relaxin and expression of vaginal wall relaxin receptor may correlate with the pelvic floor dysfunction in late pregnant women.
ABSTRACT
Objective To identify the morphological characteristics of pelvic diaphragm hiatus in pregnant women with stress urinary incontinence ( SUI) by transperineal three-dimensional (3-D) ultrasound.Methods From Oct.2008 to Mar.2009,145 pregnant women (third trimester group) at 37-41 weeks of gestation underwent transperineal 3-D ultrasound investigation at Department of Obstetrics and Gynecology,the Sixth People's Hospital,Shanghai Jiaotong University,including 38 pregnant women with stress urinary incontinence (SUI) and the other 107 non SUI pregnant women.In the mean time,50 normal nulliparous healthy women were chosen as control group.The morphological characteristics of pelvic diaphragm hiatus,the diameter of pelvic diaphragm hiatus,pubovisceral muscle thickness and genitohiatal and levator ani angle were measured at rest,on maximum Valsalva and maximum pelvic floor contraction by 3-D ultrasound,respectively.Results Loosen connective tissue and pubococcygeus avulsion were observed in some pregnant women at third trimester.The area of pelvic diaphragm hiatus were (15.2 ±1.9),(16.4 ± 2.0) and (13.6±1.9) cm2,pubovisceral muscle thickness were (0.72 ±0.11),(0.68 ±0.14) and(0.77 ±0.11) cm,levator ani angle were (60 ±8) °,(57±10) ° and (64 ± 14)° at rest,on maximum Valsalva and maximum pelvic floor contraction respectively.These parameters were significantly increased than those in control group[(11.2 ±2.6),(14.5 ±4.5) and (9.2 ±2.6) cm2; (0.66 ±0.10),(0.67 ± 0.14) and (0.71 ±0.14) cm; (50 ±4) °,(51 ±5) ° and (46 ±5)°]at three maneuvers,respectively ( P <0.05).And those parameters of the anteroposterior hiatal diameter,lateral hiatal diameter,perimeter of pelvic diaphragm hiatus and area of pelvic diaphragm hiatus in SUI pregnant women were increased than those in non SUI pregnant women at three maneuvers,respectively (P < 0.05 ).Pubovisceral muscle thickness in SUI pregnant women was significantly lower than that in non SUI pregnant women at maximum pelvic floor contraction (P < 0.05 ),but there were not significant difference between SUI and non SUI pregnant women at rest and on maximum Valsalva in pubovisceral muscle thickness and genitohiatal and levator ani angle (P >0.05).Conclusions Pelvic floor anatomic remodeling is identified in late pregnant women.When compared with non pregnant women,the loosen pelvic floor connective tissue and the bigger diameters of pelvic diaphragm are observed in late pregnant women.It is observed that the increased diameters of pelvic diaphragm and decreased thickness of pubovisceral muscle in later pregnant SUI women than those in non SUI pregnant women.